tulonge afya

1USAID TULONGE AFYA QUARTERLY REPORT | OCT 2019 - DEC 2019

QuarterlyPerformanceReport(FY20)

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USAID Co-operative Agreement: AID-621-A-17-00002

Submitted by: FHI360

Submitted to: Linda Madeleka, Agreement Officers Representative

USAID/Tanzania

Contact person: Waziri Nyoni

[email protected] | +255 787 382 857

Tulonge Afya

2 USAID TULONGE AFYA QUARTERLY REPORT | OCT 2019 - DEC 2019

Table of Contents

Acronyms 3

Executive Summary 4

Project Background 5

USAID Tulonge Afya by the Numbers 5

Summary Achievements by Funding Stream 12

Achievements by Result Area 13

Result 1: Improved ability of individuals to practice healthy behaviors 13

Result 2: Strengthened community support for healthy behaviors 26

Result 3: Improved systems for coordination and implementation of SBC interventions 31

Upcoming Main Activities in Q2 33

Success Stories 34

List of Annexes 35

This quarterly report is made possible by the support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-621-A-17-00002, with FHI 360 as the prime recipient. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.


Acronyms

AGYW Adolescent Girls and Young WomenANC Antenatal CareART Antiretroviral TherapyCCHP Comprehensive Council Health PlanCHW Community Health WorkerCIRC Voluntary Medical Male Circumcision (PEPFAR Budget Code)CSO Civil Society OrganizationCTC Care and Treatment CenterDC District CouncilDHIS2 District Health Information System 2D/RHPC District/Regional Health Promotion CoordinatorEBF Exclusive BreastfeedingEPI Expanded Program on ImmunizationEVD Ebola Virus DiseaseFHI 360 Family Health InternationalFP Family PlanningFS Funding StreamFY Fiscal YearGBV Gender-based ViolenceGOT Government of TanzaniaHIV Human Immunodeficiency VirusHIVST HIV Self TestingHKID Orphans and Vulnerable Children (PEPFAR Budget Code)HPS Health Promotion SectionHTC HIV Testing and CounselingHTXS HIV Care and Treatment (PEPFAR Budget Code)IR Intermediate ResultIRB Institutional Review BoardIRS Indoor Residual SprayingIP Implementing PartnerIPC Interpersonal Communication IPT Intermittent Preventive TreatmentITN Insecticide Treated NetKVP Key and Vulnerable PopulationLLIN Long Lasting Insecticide Treated NetLTFU Loss to Follow UpM&E Monitoring and EvaluationM4RH Mobiles for Reproductive HealthMCM Modern Contraceptive MethodMNCH Maternal, Newborn, and Child HealthMOHCDGEC Ministry of Health, Community Development, Gender, Elderly, and ChildrenNACP National AIDS Control Program

NMCP National Malaria Control ProgramNTLP National Tuberculosis and Leprosy ProgramPEPFAR President’s Emergency Plan for AIDS ReliefPLHIV People Living with HIVPMI President’s Malaria InitiativePMTCT Prevention of Mother-to-Child Transmission of HIVPNC Post-Natal CarePORALG President’s Office of Regional Administration and Local GovernmentPPFP Post-Partum Family PlanningPrEp Pre-exposure ProphylaxisPSA Public Service AnnouncementQ&A Question and AnswerRCCE Risk Communication and Community EngagementRCHS Reproductive and Child Health SectionR/CHMT Regional/Council Health Management TeamSBC Social and Behavior ChangeSBCC Social and Behavior Change CommunicationSNET Social Norms Exploration ToolSNP School Net ProgramSRH Sexual and Reproductive HealthT-MARC T-MARC Tanzania TA Technical AssistanceTAC Technical Advisory CommitteeTACAIDS Tanzania Commission for AIDSTB TuberculosisU=U Undetectable = UntransmittableUSAID United States Agency for International DevelopmentUSG United States GovernmentVMMC Voluntary Medical Male CircumcisionWAD World AIDS DayWHO World Health OrganizationY YearZAMEP Zanzibar Malaria Elimination Program

Executive Summary


USAID Tulonge Afya is pleased to share its quarter one FY20 report, highlighting work completed, and successes achieved during the quarter.

During this first quarter of FY20, the project continued to implement its core activities towards achievement of its goals. Key activities implemented include, but are not limited to, the design and implementation of 5 anchors show episodes produced in ready to broadcast format for new seasons of the NAWEZA anchor show; support for school net distribution, including refreshed post-School Net Program (SNP) messages; Developed a concept note to inform SNET Operationalization Plan to inform deepened community-level FP interventions under NAWEZA to address myths, misconceptions, and negative norms hindering FP uptake; and demand creation activities towards the uptake of antiretroviral therapy (ART) and tuberculosis (TB) services, as well as for community-based distribution of ART and FP/HIV integrated services. USAID Tulonge Afya continued to produce and distribute SBC materials and implemented its mass media plan whereby NAWEZA anchor shows were aired.

Community activities continued to be implemented to reach targeted audiences using three project platforms Furaha Yangu, NAWEZA, and SITETEREKI using small group dialogues and IPC, and complemented by mid and mass media. By the end of the quarter, 49,289 individuals were reached through Furaha Yangu targeted small group dialogues, and 45,748 individuals were reached through the NAWEZA platform. Also, by the end of the quarter, USAID Tulonge Afya and its partners reached 48,528 youth through SITETEREKI.

In its effort to strengthen capacity of government stakeholders, the project conducted a three-day SBC basics workshop with 33 senior officials from national level PORALG health department leadership. The workshop aimed to increase awareness and understanding of the role of contemporary SBC approaches in transforming social norms and promoting healthy behaviors.

Despite these achievements, the project continued to face some challenges, including delays in receiving approvals for SBC materials. This led to delays in implementation of several key activities. Efforts were made to address this challenge and the delayed materials will be approved with caregiving activities implemented during quarter two of FY20.


Project Background

ResultsImproved ability of individuals to practice healthy behaviors.

The USAID Tulonge Afya project catalyzes opportunities for Tanzanians to improve their health status by transforming socio-cultural norms and supporting the adoption of healthier behaviors. By addressing key social and cultural norms and social behavior change (SBC) needs, USAID Tulonge Afya identifies the drivers of behaviors directly tied to health and leverages social and behavior change (SBC) and other mutually-reinforcing approaches to achieve the following results:

Strengthened community support for health behaviors.

Improved systems for coordination and implementation of SBC interventions.

1 2 3

USAID Tulonge Afya by the NumbersTABLE 1. TOTAL NUMBER OF PEOPLE REACHED THROUGH COMMUNITY-LEVEL SBC ACTIVITIES IN FY20 Q1

No. Reached

FURAHA YANGU 49,289

NAWEZA 48,528

24%*

Achievement Against Target (%)

68%

SITETEREKI 45,748 97%

TOTAL 21,928 12%*

209,435

Quarterly Target

71,810

46,958

187,4928

1 Cultural theater activities were not categorized by platform in Q1; this will be addressed in monitoring tools during FY20

*Quarterly target for Furaha Yangu, and cultural theater were not achieved because of delay in engagement of CSOs following delay in approval of FY20 budget. So, few activities were conducted during the quarter.

TABLE 2. TOTAL NUMBER OF PEOPLE REACHED THROUGH COMMUNITY-LEVEL SBC ACTIVITIES BY AGE, SEX, AND PLATFORM

Total Number of People Reached through Community-level SBC Activities by Age, Sex, and Platform

Sex/Age Male Female

10-14 15 -17 18 - 24 25 - 30 31 - 49 50+ Total 10-14 15 -17 18 - 24 25 - 30 31 - 49 50+ Total

FURAHA YANGU 7 246 8,153 9,730 10,766 534 29,436 21 260 6,826 6,235 6,244 267 19,853

SITETEREKI 7,522 16,961 24,483 10,589 13,456 24,045

NAWEZA 19 2,529 5,390 6,980 265 15,183 2 306 10,952 10,220 8,674 411 30,565

CULTURAL THEATER 1,317 1,799 2,119 2,238 2,022 1,089 10,584 1,352 1,864 2,407 2,323 2,235 1,163 11,344


Total Number of People Reached with SBC Community Interventions per activities attended for all platforms (FURAHA YANGU, NAWEZA, and SITETEREKI)

Region Attended at least one activity

Attended at least two activities

Attended at least three activities

Attended four activities

Proportion attended four

activities Arusha 9,272 9,181 8,618 7,673 83%

Geita 8,178 8,178 7,440 7,373 90%

Iringa 11,101 11,089 10,839 10,713 97%

Kagera 18,684 18,679 18,106 17,807 95%

Kigoma 7,427 7,427 7,165 7,110 96%

Mara 8,882 8,882 8,315 8,179 92%

Mtwara 7,565 7,564 7,404 7,369 97%

Mwanza 14,026 14,000 12,758 12,081 86%

Njombe 7,742 7,740 7,540 7,434 96%

Shinyanga 12,969 12,969 12,106 11,868 92%

Singida 4,586 4,586 4,471 4,451 97%

Tabora 27,178 27,143 26,334 24,683 91%

TABLE 3. TOTAL NUMBER OF PEOPLE COMPLETING A FULL PACKAGE OF COMMUNITY SBC ACTIVITIES, BY REGION

*Completed at least four activities out of a multi-session intervention

TABLE 4. TOTAL NUMBER OF INDIVIDUALS REACHED THROUGH DIGITAL PLATFORM BY AGE, SEX, AND HEALTH AREA

Family Planning 188 89325,633

13,472

28,000

Themes Total 10-14 15-19

MNCH*

20-24 25-30 31-49 50+ TotalM | F M | F M | F M | F M | F M | F M | F

1335 4964 2379 7253 1630 3863 913 1816 174 224 6620 19013

0 0 0 0 0 0 0 0 0 0 0 0 0 0

530 547 3375 2181 4862 3216 3930 2437 3773 1999 794 356 17264 10736

0 09,365

16,306

0 0 0 0 0 0 0 0 0 0 0 0

838 660 2671 1598 2387 1641 1716 1163 1709 1055 600 268 9921 6385

Total

HIV/AIDS

TB

Malaria

*Maternal, Newborn, and Child Health - The platform does not provide age and sex segregated user data for these topics


Note: Number of social media reach/views can be higher than the total number of social media followers/fans. Digital social media ads are used to increase reach and engagement to more people via targeted ads.

FIGURE 1. NUMBER OF PEOPLE REACHED THROUGH SOCIAL MEDIA

Total

FAMILY PLANNING (FP) UZAZI WA MPANGO FEMALE MALE TOTAL

What is FP? Elimu ya uzazi wa mpango 5,727 2,255 7,982

Methods Njia ya uzazi wa mpango 5,961 1,650 7,611Pregnancy prevention Kujikinga na mimba zizizotarajiwa 4,802 1,529 6,331

Youth stories Hadithi zinazohusu uzazi wa mpango 2,572 1,137 3,709

HIV/AIDS UKIMWI/VVU FEMALE MALE TOTAL

HIV testing Kupima 3,422 6,780 10,202Testing positive for HIV Ukigunduka una VVU 2,906 4,717 7,623

Antiretroviral therapy (ART) use Matumizi ya Dawa za ARV 1,870 2,544 4,414

Life after testing positive for HIV Maisha baada ya kugundulika na VVU 2,563 3,198 5,761

MALARIA MALERIA FEMALE MALE TOTAL

Knowledge seeking Ujue Ugonjwa wa malaria 2,250 4,154 6,404How to prevent malaria Kinga ya malaria 1,648 2,834 4,482

Malaria treatments Matibabu ya malaria 1,011 2,022 3,033Malaria during pregnancy Malaria wakati wa ujauzito 1,462 925 2,387

TABLE 5. NUMBER OF INDIVIDUALS ACCESSING DIGITAL PLATFORM BY SEX AND SUB-TOPIC.

SOCIAL MEDIAFANS & FOLLOWERS

SOCIAL MEDIACONTENT VIEWS

On average, 4.8m+ Tanzanians are active on social media monthly

DIGITAL BILLBOARD ADS

Reach/views on blogs/websites

ENGAGEMENT Comments/likes/shares

27,00075,500

4.4m+2.4m+

2.4m+

143,500+138,000+


Number of Radio Spots Produced and Aired Q1 FY20

Platform Health Area Topic Number Produced Number of Airings

NAWEZA thematic radio spots

Antenatal care (ANC) Male involvement

4 1,563Facility delivery Female supportService provider supportFacility delivery

ANC Male involvement 20 235

NAWEZA BRAND PUSH December festive season campaign

Facility delivery Female supportPostnatal care (PNC) Service provider support

Facility delivery

Number of Print Materials Produced and Distributed Q1 FY20

Platform Material Description Number Produced Number Distributed

NAWEZA NAWEZA floating frames 15 15

SITETEREKI

Gazebo 12 12Weka condom Kwenye mpango books 200,000 200,000Safari ya Juma books 994,600 994,600Rollup banner-broadbase 30 30Sitetereki folders 5,000 5,000Posters (five variations) 20,000 20,000Polo t-shirts 850 850Caps 1,000 1,000Wristbands 20,000 20,000Canvas bags 6,000 6,000Backpacks 1,000 1,000

FURAHA YANGU

Furaha Yangu Phase 2 & 3 Materials (Adherence, U=U, Viral Load Testing, Self-Risk Profiling & Index Testing for Men)

703,006 703,006

World AIDS Day 2019 materials 423 423 TB Caucus materials 10 10

TABLE 6. NUMBER OF RADIO SPOTS AIRED BY HEALTH AREA

TABLE 7. NUMBER OF PRINT MATERIALS PRODUCED AND DISTRIBUTED


Services uptake data showing attribution of USAID Tulonge Afya SBCC activities with service delivery uptake

HIV: HIV TESTING THROUGH FURAHA YANGU (>15 YEAR OF AGE) ACROSS 29 ENHANCED USAID TULONGE AFYA DISTRICTS

NAWEZA:

500,000

250,000

125,000

0

3%

1.5%

0%

4.5%

Total Tested HIV Yield

6%

4.1%

3.2% 2.9%2.7%

2.8%

4.9%

Q1 FY18 Q3 FY18 Q4 FY19Q3 FY19Q1 FY19 Q2 FY19

FIGURE 2. PERCENTAGE OF HIV TESTING AND POSITIVITY PER QUARTER AMONG 29 ENHANCED DISTRICTS WITHIN 12 USAID TULONGE AFYA SUPPORTED REGIONS

Q2 FY18 Q4 FY18

375,000

3.3%

4.6%

HIV Positive

Q1 FY20

5.7%

130,000

65,000

32,500

0

35%

18%

0%

53%

ANC1 Proportion IPT3 uptake

70%

33% 37%

42%54% 58%

68%


FIGURE 3. TREND OF ANC 1 AND IPTP3 UPTAKE PER QUARTER

Q2 FY18 Q4 FY18

97,50059%

62%

IPT3

Q1 FY20

68%


130,000

65,000

32,500

0

50%

25%

0%

75%

ANC1 Proportion received LLIN ANC

100%

42%

66%73% 74%

84%

91%


FIGURE 4. TRENDS OF ANC1 BOOKING AND LLIN PROVISION

Q2 FY18 Q4 FY18

97,500

91%

87%

ANC LLIN

Q1 FY20

86%

130,000

65,000

32,500

0

40%

20%

0%

60%

ANC1 Proportion completed ANC4

80%

46%49%

51%58% 64%

72%


FIGURE 5. TRENDS OF PROPORTION OF ANC4+ ATTENDANCE PER QUARTER

Q2 FY18 Q4 FY18

97,500 63%66%

ANC4

Q1 FY20

80%


SITETEREKI:

FIGURE 6. TREND OF CONTRACEPTIVE UPTAKE AMONG YOUTH 15-24 YEARS WITHIN 29 ENHANCED DISTRICTS

IUCDImplants (15-24)

12,500

0

25,000

37,500

50,000

Pills (15-24)

OCT - DEC 2019

JUL - SEP 2019

APR - JUN 2019

JAN - MAR 2019

Injectables (15-24)

MALE (15-24)

HIV TestingHIV Positive

FEMALE (15-24)

12,500

0

25,000

37,500

50,000

30,661

570

FIGURE 7. HIV SERVICE UPTAKE AMONG YOUTH Q1 FY20 ( OCT-DEC, 2019)

49,162

1,539

HIV Positivity

1%

0%

2%

3%

4%

2%

3%

MALE (15-24) FEMALE (15-24)

1,500

0

3,000

4,500

6,000

5,553

FIGURE 8. CONDOM UPTAKE AMONG YOUTH Q1 FY20

874


ACTIVITY ACHIEVEMENTSFUNDING STREAM

SUPPORTDesign and implement two new seasons of the NAWEZA anchor show

• 5 anchors show episodes produced in ready to broadcast format FP, MalariaMNCH

Continue to roll out the Parenting and Caregiving package

• Core set of materials finalized and submitted for approval• IPC toolkits and implementation guides reviewed to strengthen FP content

FP,Malaria,MNCH

Develop and air regionally contextualized radio spots aimed at addressing key drivers of NAWEZA priority gateway behaviors

• Thematic pregnancy and childbirth radio spots aired 1,563 times across six regional radio stations for an extended period of four weeks

• A four-week, brand awareness push media campaign was deployed across two leading national radio stations

FP,Malaria,MNCH

Support School Net distribution and refresh post-school net program (SNP) messages

• SNP student take away fliers refreshed and two million pieces procured for use during net distribution activities

• Community level activity tools and orientation resources finalized and produced for use

Malaria

Deepen community-level FP interventions under NAWEZA to address myths, misconceptions, and negative norms hindering FP uptake

• Development of a concept note to inform SNET Operationalization Plan FP

Broadcast thematic SITETEREKI radio spots developed in FY19, regionalizing content where required

• 5 thematic radio spots finalized and submitted for approvals HIV:HVCT,HIV:CIRC,FP

Develop and roll out male-tailored demand creation support materials

• Ministry of Health, Community Development, Gender, and Elderly (MOHCDGEC) approval against Furaha Yangu Phase II and III submitted materials secured

• Furaha Yangu Phase II and III SBC resource package introduction and orientation meeting conducted with national level stakeholders

HIV: HVCT,HIV:HXS,TB HL.2

Roll out demand creation activities towards the uptake of ART and TB services, community-based distribution of ART, and FP/HIV integrated services

• 194 Furaha Yangu Treatment Advocates recruited, trained, and deployed across 31 PEPFAR high priority sites

• Over 765,000 Furaha Yangu Phase II and III print materials procured and distributed to support community level activities

HIV:HVCT,HIV:HXS,TB HL.2,FP

Develop and roll out IPC counseling job aids including print support materials to improve self-testing and index testing counseling sessions at the community and facility level

• Technical meeting conducted to agree on pre-exposure prophylaxis (PrEP) and HIV self testing (HIVST) SBC priorities and to draft content with national level stakeholders

• Development of creative briefs to inform PrEP introductory demand creation materials

HIV:KP

Digitalizing the NAWEZA, SITETEREKI, and Furaha Yangu messages and content to fit within mHealth platforms

• NAWEZA digital and social media activities generated over 4.4 million impressions (number of times content is seen) and 143,500 engagements

• Furaha Yangu digital and social media content received 2.4 million impressions, of which 97% were from men

• Adaptation of HelpStopTheVirus.Com Gilead Science 5 minutes video to bridge treatment literacy gaps, through the introduction of U=U concepts and stories

MNCH

HIV:TXS

Provide targeted SBC technical assistance (TA) and support to government partners, including health days

SBC TA and Support to United States Government (USG) implementing partners (IPs) and the Government of Tanzania (GOT)• Development and production of a core set of SBC messages and materials to

support key GoT initiatives:- o 2019 World Aids Day National Commemoration events o TB Caucus Parliamentarian Faith Leaders engagement and advocacy campaign o Zanzibar Malaria Elimination Program (ZAMEP) new malaria case

management awareness campaign• Finalized and shared demand creation public service announcement (PSA) and

posters promoting youth-friendly sexual and reproductive health (SRH) services across USAID Boresha Afya-supported sites

TABLE 8. SUMMARY OF KEY ACHIEVEMENT BY FUNDING STREAMS

Summary Achievements by Funding Stream


Achievements by Result Area A narrative summary of achievements against activities delineated in USAID Tulonge Afya’s FY20 work plan is provided by result area below.

Improved ability of individuals to practice healthy behaviors.

1

IR 1.1 DEEPEN AND CONTINUE IMPLEMENTATION OF THE NAWEZA PLATFORM FOR ADULT AUDIENCES 1.1.3 Design and implement two new seasons of the NAWEZA anchor show and increase linkages between the show with social media and community-level activities Following the work which began at the end of FY19, the project continued production of Season Two of the NAWEZA anchor show during the quarter, by recording five episodes, which addressed the following priority behaviors: insecticide treated net (ITN) use for children under 5, post-partum family planning (PPFP) (two episodes), early care-seeking for newborn illnesses, and early care-seeking for a fever. By the end of the quarter, the episodes were in post-production and are ready for airing early in Q2. The current NAWEZA anchor show production status as of Dec 2019 is outlined in table 9 below.

TABLE 9. SEASON TWO PRODUCTION SCHEDULE

CAREGIVING <5KEY BEHAVIOURS

SET 1Production Timeline

(Q4 – FY2019)


(Q1 – FY20)


Q2 – FY20

Episo

de 1

Episo

de 2

Episo

de 3

Episo

de 4

Episo

de 5

Episo

de 6

Episo

de 7

Episo

de 8

Episo

de 9

Episo

de 10

Episo

de 11

Episo

de 12

Sleep under an ITN, incl. <5 XUse modern contraceptive method MCM (avoid preg. for 24 months) X X X*

Exclusively breastfeed (EBF) for 6 months X XSeek care for signs of newborn illness X X XSeek prompt care for <5 with fever XTimely immunization of infants and <2 X

Integrated FP/HIV (norms) Cross-cutting norms, fertility worries, couples talk XAdolescent SRH access (youth-parent dialogue) Norms, beliefs, attitudes keeping youth from FP X*additional FP script to reflect USAID funding prioritiesKEY Ready to air

In production or post-productionIn scripting


Upcoming episodes to be broadcast in Q2 were actively promoted on NAWEZA’s Instagram and Facebook pages (@Naweza TZ), which have over 27,000 followers. This content was viewed over 4.4 million times, generating over 143,000 engagements (likes, shares, comments). All season two episodes will also direct listeners to NAWEZA’s social media pages, where audiences will have the opportunity to listen to the show on-demand via the show’s podcasting platform: https://anchor.fm/naweza-show.

1.1.5 Continue to roll out the Parenting and Caregiving package, refreshing and intensifying radio media and print material support across MNCH and FP priority regions

Work to progress the Parenting and Caregiving package continued this quarter in partnership with the Health Promotion Section (HPS), the Reproductive and Child Health Section (RCHS), and National Malaria Control Program (NMCP). Materials listed in table 10 below were finalized reflecting pre-test refinement recommendations and final stakeholder technical reviews and were submitted to the MOHCDGEC for approval. Key pre-test recommendations included the need to contextualize the models used to make them more relatable. Additionally, while some caregiving package print materials used the concept of children as change agents to deliver key call to action messages to caregivers of under 5-year olds, pretest findings suggested that most participants were uncomfortable with this approach. Culturally, participants felt that most Tanzanians, including themselves, feel it is inappropriate to showcase children giving their elders instructive messages, even in humour. Following this feedback the creative direction was repurposed to have parents at the center, with children featured to reinforce the Caregiving focus of these materials.


Channel Type Targeted Priority Behavior

RADIO

Radio spot ITN UseFP• Spacing• Male endorsement• Mitigating fear of side effectsExclusive breastfeeding (EBF)Care seeking for newborn illnessCare seeking for malaria and promotion of:• Sense of urgency at the onset of fever symptoms• Dose completionImmunization

PRINT

Posters ITN UseFP• Spacing• Male endorsement• Couple’s dialogueEBF• For parents/caregivers• For providers (to support EBF)Care seeking for newborn illness• For parents/caregivers• For providers (pediatric TB diagnosis)Care seeking for malaria (fever)Immunization

Cards FP invitation card (spacing)Immunization reminder card Key Caregiving Actions reminder cards (Integrated, addresses all behaviors)

Brochures FPEBFComplementary feedingCare seeking for malaria (fever)Immunization

TABLE 10. LIST OF PARENTING AND CAREGIVING PACKAGE MATERIALS SUBMITTED TO MOHCDGEC FOR APPROVAL

IPCCommunity dialogue: Timed Household Visit IPC cards

All Pregnancy and Caregiving Package priority behaviors

MID MEDIA

Community radio supplementary topic guides

ITN use EBFCare seeking Immunization

Community theater story summaries/scripts

Six story summaries for caregiving for under-fives in English & Kiswahili (ITN use, FP, EBF, Careseeking (Newborn Illness), Careseeking (Fever), Immunization.


During the quarter, the Parenting and Caregiving package community IPC toolkits, implementation guides, sample community theater scripts, and accompanying discussion guides, were also refined to strengthen FP content addressing method use concerns, and myths and misconceptions, while placing a greater focus on addressing norms related to couple’s dialogue. Refinements made included the inclusion of standardized content that addresses hormonal MCM use side effects concerns, especially related to fertility, the appropriate age to initiate use, and the importance of male partner support. These resources and materials will be finalized early next quarter to ensure the project is well poised to roll out and implement community-level activities in tandem with mass media support.

1.1.6 Develop and air regionally contextualized radio spots aimed at addressing key drivers of NAWEZA priority gateway behaviors (ANC, facility delivery, PNC, PPFP/FP, HIV testing stigma and discrimination)

The Pregnancy and Childbirth package radio spots that were developed and broadcast in FY19 were re-aired for an extended period of four weeks this quarter across six districts (Uyui district council [DC], Waningombe DC, Singida DC, Newala DC, and Rorya DC) that had lower improvements in behavioral determinants related to ANC and facility delivery based on USAID Tulonge Afya monitoring and evaluation data. Specifically, these included; i) Percentage of pregnant women who believe going to ANC early and more than 4 times, regardless of parity, benefits them and their baby, ii) Percentage of pregnant women who believe they will receive quality services at the health facility, iii) Percentage of pregnant women who believe that getting a postnatal check-up benefits them, regardless of parity or place of delivery, and iv) Percentage of women who believe their partner supports the use of an MCM, post partum. Towards this, a total of 1,563 spots which reached 1,715,798 listeners were aired across six regional radio stations (CG FM, Kings FM, Sengerema FM, Newala FM, and Bunda FM) to complement and further support community-level activities.

In addition to airing of the thematic radio spots, a four-week brand push campaign was aired across two leading national radio stations – Clouds FM and RFA – during the 2019 holiday season (December to January) to strengthen the reach and exposure to the NAWEZA brand. The brand push was driven by scripted presenter mentions with tailored holiday messaging using relevant ‘triggers’ to promote ANC attendance, completion, facility delivery preparedness, and PNC attendance. Mentions were aired through morning and evening drivetime shows, and via a football-heavy night-time sports show to promote male involvement in their partner’s pregnancy. Additionally, two versions of a holiday-themed NAWEZA signature tune (mnemonic) were deployed during this holiday push to help improve brand recognition among listeners. A total of 235 presenter mentions were broadcast with the signature tune aired 350 times over the four-week period across both radio stations, reaching 17,648,651 listeners (Ortus, Media Campaign Evaluation Report Oct to Dec 2019).

Also during this quarter, USAID Tulonge Afya updated its omnibus survey questionnaire to ensure that it collects data that will allow the project to better inform regional tailoring of mass media content and broadcasting. The first FY20 omnibus survey will take place next quarter to inform these regionalization decisions.

1.1.8 Support school net distribution and refresh post-SNP messages to align with NAWEZA malaria communication objectives to address known determinants

In Q1, USAID Tulonge Afya refreshed the SNP student takeaway flier to promote four key steps towards ITN use: net hanging, net tack-in, net use, and net care. Key changes made included content updates to conform with new President’s Malaria Initiative (PMI) guidelines on promoting net care and repair. A total of two million student takeaway fliers were printed and will be distributed concurrently with each issued ITN across 10 PMI-supported regions.


Other support provided this quarter included the development of talking points, PSAs, and mid media event training and orientation resources. These materials will be used to support the roll out and implementation of targeted SBC activities in Q2 to increase SNP awareness, acceptance, and participation in targeted communities across 75 districts. Annex 6 is a concept note for this activity. To reinforce community level activities, the project will also support the broadcast of 3,080 radio spots to raise awareness of the school net distribution and focused on net use and net sharing. These spots will be aired across 10 regional radio stations from January to February 2020. Annex 1 and 2 indicates the radio stations engaged to support the SNP and the SNP media plan.

1.1.9 Deepen community-level FP interventions under NAWEZA to address myths, misconceptions, and negative norms hindering FP uptake

Building on a two-day Social Norms Exploration Tool (SNET) orientation workshop that was facilitated by the Passages Project in FY19, USAID Tulonge Afya developed a concept note this quarter outlining how the project will operationalize the SNET to deepen its FP activities. Designed to identify and unpack deeply rooted social norms which hinder the uptake of FP services and MCMs among youth and adults aged 15 to 49 years, USAID Tulonge Afya’s use of the SNET will seek to achieve the following objectives:

• Identify key influencers in the uptake of FP/RH information and services and the nature of relationship with the target groups

• Explore social norms that contribute to early pregnancies among unmarried female youth • Explore norms that hinder consistent and correct condom use among unmarried male youth • Explore social norms that hinder child spacing for two years among married couples • Explore norms limiting health care workers’ provision of FP/RH information and services to adolescents

and youth • Explore social norms associated with health care workers’ provision of impartial FP services to women and

men regardless of age, parity and marital status • Explore sanctions and rewards for engaging in certain behaviors and the expectations of reference groups

to the performance and non-performance of these behaviors

Two regions – Kigoma and Tabora – have been identified for this activity based on low CPR (Kigoma 18% and Tabora 21%) and high rate of teenage pregnancies (Kigoma 32% and Tabora 43%). This quarter, the protocol was developed and submitted to the National Institute for Medical Research (NIMR) for local institutional review board (IRB) approval. It is anticipated that data collection will commence mid Q2 once IRB and local approvals are secured.

IR 1.2 DEEPEN AND CONTINUE IMPLEMENTATION OF THE SITETEREKI PLATFORM FOR YOUTH AUDIENCES

1.2.3 Broadcast thematic SITETEREKI radio spots developed in FY19, regionalizing content where required, to increase adoption of healthy behaviors as per the updated strategy

This quarter, five thematic radio spots developed in FY19 addressing HIV testing, voluntary medical male circumcision (VMMC), condom use, and FP (attached as annex 3) were pretested with youth in Iringa for relevance, appropriateness, connection, and credibility. Results were used to inform refinements, with spots submitted to HPS for approval in November.

Pretest insights for HIV testing included young people connecting with the character’s determination to test for HIV, saying many in their communities were far too afraid of being found positive. For FP, audiences connected with a spot that promoted


dialogue between parents and their children, indicating that while it rarely happens, the spot “establishes a new norm where girls are more comfortable soliciting advice about health issues, including FP, from their elders.” Results from these pretests were used to inform refinements to the media, with final spots submitted to HPS for approval in November.The project also developed a comprehensive 8-month media plan for the SITETEREKI brand covering radio spot placement, sponsorship and mention opportunities, and event and social media tie-ins (attached as annex 4). The plan was submitted to HPS for approval, with a broadcast start date set for early Q2.

IR 1.3TARGET AND TAILOR FURAHA YANGU SBC ACTIVITIES TO ADDRESS PEPFAR AND GOT PRIORITIES

1.3.2 Develop and roll out male-tailored demand creation support materials to promote the uptake of HIV services, benefits of early detection, and ART adherence and retention in care Designed to support targeted SBC interventions for people living with HIV (PLHIV) and those at higher risk for HIV, USAID Tulonge Afya developed and secured MOHCDGEC approval for an array of male-tailored SBC materials in FY19 (attached as annex 7).

These materials seek to help men assess their HIV risk, get themselves and their partners tested (index testing), adhere to treatment if living with HIV, aspire to achieve undetectable = untransmissible (U=U) status (viral load testing), and keep their care and treatment (CTC) appointments. They were procured and rolled out across six project-supported regions with the highest HIV burden (Tabora, Njombe, Iringa, Arusha, Singida, and Mtwara) this quarter.

FIGURE 10. TARGETED POSTER FOR VIRAL LOAD TESTING AND MONITORING TO ACHIEVE U=U.

SBC materials were also made available to partners towards the end of Q1 through a one-day Furaha Yangu stakeholder orientation meeting hosted by NACP, during which USG IPs were briefed on the use and availability of materials and were provided samples and rollout-ready digital artwork for them to produce, distribute, and use.

Concurrently, this quarter the project developed an eight-month media plan for Furaha Yangu, which is set to begin broadcasting early in Q2. Three 60-second radio spots were developed to address low HIV risk perception and HIV testing fears. These will be aired strategically to engage men at higher risk for HIV but with low risk perception.


1.3.3 Roll out demand creation activities towards the uptake of ART and TB services, community-based distribution of ART, and FP/HIV integrated services for hard-to-reach populationsFollowing the training and certification of 25 Treatment Advocate master trainers in FY19, 194 PLHIV Treatment Advocates (stable clients with at least six years of ART use and adherence) were recruited, trained, and deployed across 31 PEPFAR priority sites in six regions this quarter in collaboration with the National Council of People Living with HIV.

The trainings aimed to equip the Treatment Advocatess with the knowledge and skills required to implement Furaha Yangu community activities with PLHIV who know their HIV status but are having challenges adhering to treatment or staying in care. This included orienting the Treatment Advocates on the Furaha Yangu PLHIV small group discussion guide and supportive print resources. Updated to include index testing, TLD transition, and viral load content, and U=U concepts and stories to bridge treatment literacy gaps, the community resources and toolkits were also procured and distributed this quarter (table 11) in support of community level activities.

MATERIAL NUMBER

Facility and community level postersIndex testing-partners 6,550Index testing-children 6,550Adherence 6,550Viral load testing 6,550Intermittent Preventative Therapy (IPT) 6,550Service announcement 6,550Service appointment 6,550HIV testing fear (men) 6,550Informational brochuresIndex testing 200,000IPT-PLHIV 200,000IPT-providers 50,000TB-HIV coinfection 100,000Integrated client care 100,000

Furaha Yangu HIV Testing Services (HTS) demand creation small group session resources

Implementation guides 915Session toolkits 4,750sets

TABLE 11. FURAHA YANGU MATERIALS PROCURED AND DISTRIBUTED TO SUPPORT TREATMENT ADVOCATE ACTIVITIES

1.3.4 Develop and roll out IPC counseling job aids including print support materials to improve self-testing and index testing counseling sessions at the community and facility level In Q1, USAID Tulonge Afya began development of HIVST and PrEP materials. With NACP, the project coordinated a meeting with GOT counterparts, USAID, and IPs to prioritize immediate SBC support needs related to PrEP and HIVST and to begin development of content for SBC materials. Subsequently, the project developed creative briefs for print and broadcast materials, including posters, brochures, a HIVST instructional video, radio spots, and FAQs for clients and providers. These briefs are currently being finalized with NACP and material development is expected to commence early next quarter.


For index testing, a phone solicitation guide for providers was co-developed with PLHIV and refined with stakeholders this quarter. The guide is designed to help providers respond to challenging questions around privacy and access that they encounter during contact with sexual partners and children of HIV-positive clients. The final draft guide was shared with NACP in December, with finalization and production planned for Q2, contingent on NACP clearance.

IR 1.5ROLL OUT A BROADER MHEALTH STRATEGY IN ALIGNMENT WITH NAWEZA, SITETEREKI, AND FURAHA YANGU OBJECTIVES

1.5.1 Digitalizing the NAWEZA, SITETEREKI, and Furaha Yangu messages and content to fit within mHealth platforms The project continued to develop and post content aligned with the Pregnancy and Childbirth package objectives across NAWEZA social media platforms this quarter. The main focus was on male partner support, participation, and involvement across pregnancy priority behaviors. Content included banner ads on popular local blogs, online micro-influencer endorsements of the platform, and the use of trending content(content that has generated views/engagement trends well above the average engagement rate to similar types of content in the geographic location or area).

As of the end of the quarter, NAWEZA’s digital and social media activities received over 4.4 million impressions (number of times content is seen) and 143,500 engagements (comments, likes, and shares). Digital display banners on local blogs and other websites received over one million impressions, as summarized in Figure 11 below:

Use of trending content to address behaviors. (Male participation)

FIGURE 11. SOCIAL MEDIA CONTENTS REACH AND FOLLOWERS

ON FACEBOOK & 1844 ON INSTAGRAM

MILLION REACHED ON

SOCIAL MEDIA

with an average of 2 unique impressions per

social media user

REACHED BY DIGITAL ADS

number of times website/blog users saw Naweza banner ads

MOST REACHED GROUP

21% female | 23% male through facebook

& instagram

THOUSAND YEAR OLDS

25 4.4MILLION

2.4 25-34


Under Furaha Yangu, social media content generation and engagement was sustained across Facebook, Instagram, and Twitter to increase awareness of the importance of retention in care and index testing. At the end of the quarter the Furaha Yangu Facebook page had 71,000 fans and the Instagram account had 1,884 followers. Digital and social media content received 2,400,000 impressions, of which 97% were from men.

FIGURE 12. NUMBER OF INDIVIDUALS REACHED THROUGH FACEBOOK AND INSTAGRAM PAGE

ON FACEBOOK & 1900 ON INSTAGRAM

MILLION REACHED ON

SOCIAL MEDIA

with an average of 2 unique impressions per

social media user

THOUSAND

72 2.4

MOST REACHED GROUP

13% female | 31% male through facebook

& instagram

YEAR OLDS

25-34

The project adapted a five- minute HelpStopTheVirus.Com Gilead Science video which was successfully used in South Africa to address treatment literacy gaps. Designed to introduce U=U concepts and stories while promoting the importance of viral load testing, the video was endorsed for adaptation by NACP. Following script transcription, translation, pre-tests and refinements which began at the end of FY19, the video was recorded and submitted to NACP this quarter for a final round of technical reviews and endorsement. The video will be finalized in Q2, reflecting the feedback received and submitted for approval. A draft copy submitted to NACP for approval can be accessed via the link below;

https://drive.google.com/open?id=1ZxIsE5u8aqDf_y4bRiQodAcOdb_5uUz-

IR 1.7SUPPORT PARTNERS TO IMPLEMENT SBC PACKAGES AND DELIVER HIGH QUALITY SBC

1.7.1 Provide targeted SBC TA and support to government partners, including health days This quarter, the USAID Tulonge Afya project provided support for the following GOT initiatives:

1.7.1.1 World AIDS Day (WAD)As in previous years, the USAID Tulonge Afya project provided SBC support to the Tanzania Commission for AIDS (TACAIDS) during World AIDS Day. This quarter, the project supported concept development, material design, and procurement for the youth segment of WAD, and banner designs and procurement for the WAD Symposium. The project also supported production and placement of PSAs promoting the youth event, the WAD charity walk, and the national WAD commemoration day. In total, four PSAs were co-developed with TACAIDS and other stakeholders. USAID Tulonge Afya provided production support for all PSAs and radio spot buys across two national and three regional radio stations. In total, 102 spots and seven interviews were aired over a period of 11 days.


Commemorated in Mwanza, USAID Tulonge Afya was invited as a key guest speaker during the 2019 WAD symposium event. During this event the project’s Monitoring, Evaluation, and Research Director delivered a Furaha Yangu update presentation, including campaign accomplishments and contributions the to 95-95-95 targets. He also shared lessons learned and future campaign plans. In addition, the project showcased its youth HIV SBC activities as part of a collaborative presentation with youth IPs AMREF and PACT, entitled “Putting Adolescent Girls and Young Women (AGYW) first to achieve 0 stigma, 0 new HIV infections and 0 HIV-related deaths.” The project also conducted SITETEREKI Juma condom use small group dialog sessions as part of its pavilion activities during the WAD youth village events. The interactive approaches used in the games attracted a lot of youth and media attention.

1.7.1.2 TB CaucusThis quarter, the USAID Tulonge Afya project continued to offer the National TB and Leprosy Program (NTLP) SBC TA in support of the Parliamentarian Faith Leaders’ TB Caucus. At NTLP’s request, the project supported the development and layout of a new brochure showcasing the link between poor housing, poor nutrition, and the spread of TB within communities. The project also supported the design and printing of a “declaration” for faith leaders to sign to show their commitment to ending TB and adapted event branding materials.

FIGURE 13. FAITH LEADERS DECLARATION SHOWCASING THEIR COMMITMENT TO ENDING TB.

1.7.1.3 Support to ZAMEPAn increase in the number of malaria cases has been observed in Zanzibar from 262 cases (Oct – Dec 2018) to 1,495 cases (July – Sept 2019). Also, a decrease in long-lasting insecticide treated net (LLIN) uptake was observed from 60,912 LLIN (Oct – Dec 2018) to 46,420 LLIN (July –Sept 2019). In response, USAID Tulonge Afya worked with ZAMEP to provide rapid TA with the aim of increasing LLIN access and maintaining LLIN use. This included gathering audience insights from heads of households, parents and caregivers of children under 5, pregnant women, community leaders (Shehas and their representatives) and facility-based health workers to identify factors and barriers associated with LLIN uptake to inform further tailoring of SBC activities. The audience insight finding report is provided as Annex 5 and a summary table below highlights the key findings (Table 12).


S/N Key issues limiting LLIN Voucher Scheme Uptake Remedial Activities

1 Low awareness of coupon availability SBC activities – mass media, mid media

2 Shehas/Community leader biases and favoritism SBC activities – community leader advocacy and engagement meetings

3 Men demand coupon to please Shehas for future favor SBC activities – mid media activities, mass media activities 4 Only women are going to the facility for coupon redemption SBC activities – mass media, mid media

5 Service biases resulting from political and ideological differences - Shehas

Community leader advocacy and engagement meetings

6Long waiting time and ques at the health facility Advocacy and stakeholder engagement meetings to reviews

findings, update reports and develop joint corrective action plans.

7 Limited availability of the coupon and LLINs --------------------“--------------------“------------------

8Restocking supplies through the current Central Medical Stores Department (CMSD) “request & report” system takes longer than expected

--------------------“--------------------“------------------

9 Delay in submitting duplicate copies from representative of Shehas

Disseminated these findings to supply-side stakeholders for them to course-correct

TABLE 12. SUMMARY OF THE KEY FINDINGS OF MALARIA AUDIENCE INSIGHT

Secondary data analysis was also conducted to show trends between LLIN issuance rate at ANC and the Expanded Program on Immunization (EPI).

22,000

11,000

5,500

0

55%

27.5%

0%

82.5%

LLIN issued ANC Issuance rate

110%

83.5%87.6%

80.5%

OCT - DEC 2018

JAN - MAR 2019

JUL - SEP2019

APR - JUN2019

FIGURE 14. TREND OF LLIN ISSUING AMONG PREGNANT WOMENANC FIRST VISIT AND LLINS ISSUED AT ANC FY19 NATIONAL LEVEL

16,50076%

Total ANC first contact visit

OCT - DEC2019

104.4%


16,000

8,000

4,000

0

120%

60%

0%

180%

LLIN issued during MR 1 Issuance rate

240%226.9%

92.8%88%

OCT - DEC 2018

JAN - MAR 2019

JUL - SEP2019

APR - JUN2019

FIGURE 15. LLINS ISSUED DURING MR 1 AGAINST THOSE GIVEN DOSE QUARTERLY FY19 (NATIONAL LEVEL)

12,000

72.6%

MR 1 dose given

OCT - DEC2019

92%

Based on audience insight findings and secondary data analysis, USAID Tulonge Afya in collaboration with ZAMEP, conducted a stakeholders meeting to share findings and identify activities and key issues to be addressed to increase uptake of LLINs in Zanzibar. It was agreed that a total of 447 community theater performances and 234 PSAs will be implemented across nine priority districts. Existing SBC materials were revised to incorporate new findings. This included inclusion of information about where LLINs can be accessed and who is eligible to receive them across print materials, PSAs, and as part of community theatre talking points .

To supplement community level activities, three radio stations were selected and programs with high listenership were identified to air existing radio spots which promote LLIN uptake and use. These activities will begin in Q2.

FIGURE 16. FINAL POSTERS (SPACE MARKERS) FOR YOUTH-FRIENDLY SEXUAL AND REPRODUCTIVE HEALTH SERVICES FOR USAID BORESHA AFYA PARTNERS.

1.7.2 Provide targeted SBC TA and support to USG IPs This quarter, the USAID Tulonge Afya project provided the following support for IPs:

1.7.2.1 USAID Boresha AfyaUSAID Tulonge Afya finalized refinements of PSAs and posters promoting youth-friendly SRH services across 10 implementation regions following co-design sessions held with youth in Q4 of last year.

Final PSAs and posters were shared with Boresha partners for them to move forward with placement and production as needed. Additionally, the project plans to offer ‘starter pack’ support early next quarter by broadcasting four weeks of PSA placements on regional radio and a minimum set of posters, to promote available youth friendly services across supported Boresha Afya health facilities.


1.7.2.2 Support to VectorLink - ZanzibarTo support the PMI-supported indoor residual spraying (IRS) campaign in 10 districts of Zanzibar, USAID Tulonge Afya developed a radio spot as well as supporting print materials, including an IRS poster, tear off sheet, FAQ informational brochure, and leaflet. The IRS activity will start on 12th February 2020 and implementation will take place for 12 days.

1.7.1.3 Support to Kizazi KipyaFollowing the incorporation of pretest recommendations in FY19, a stakeholders meeting was conducted to review the refined digitalized gender-based violence (GBV) interactive dialogue toolkit. The toolkit was then finalized, reflecting final feedback received, and submitted to PACT Tanzania to use across their program activities (attached as annex 8).


Strengthened community support for healthy behaviors

2

IR 2.2 FURTHER CUSTOMIZE COMMUNITY GRANTS PROGRAM ACTIVITIES AND FOCAL AREAS BASED ON DISTRICT HEALTH NEEDS, DATA, AND PRIORITIES

2.2.1 Align community-level SBC activities based on district data and priorities In Q1, USAID Tulonge Afya began aligning its community level activities based on district priorities. The project used DHIS2 data for three key indicators 1) wards with high teenage pregnancy, 2) wards with high HIV incidence, and 3) wards with low ANC attendance to identify areas where intensified community-level activities are needed. To support these intensified activities, additional peer champions have been identified and recruited. Newly recruited volunteers will be trained and begin implementing activities in Q2.

2.2.2 Work closely with IPs, regional and district GOT to provide SBC support and ongoing TA to civil society organizations (CSOs) to achieve service delivery targets During this reporting period, USAID Tulonge Afya, in collaboration with Council Health Management Teams (CHMTs) conducted supportive supervision visits to CSOs implementing community level activities across 29 enhanced districts. CHMT members observed volunteers facilitating NAWEZA, SITETEREKI, and Furaha Yangu small group sessions. Key observations from these field visits included:

• Some volunteers – those who had facilitated few group sessions – were identified to have performance issues. CSO staff were provided with recommendations on how to raise the performance of low performing volunteers, including provision of on-the-job coaching, peer coaching/learning, and closer follow up.

• Office documentation and filling systems in some CSO offices were insufficient. CSO staff were advised to arrange and file documents properly for easy accessibility and confidentiality.

2.2.3 Enhance targeted HIV testing, ART enrollment, adherence, and retention in care andtreatment services in PEPFAR-supported high volume sites In FY19, USAID Tulonge Afya identified and trained 194 PLHIV Treatment Advocates to implement community level SBC activities as part of the Furaha Yangu campaign. Immediately after the training, Treatment Advocates began implementing community level activities to link loss-to-follow up (LTFU) clients back to services and engage PLHIV who have not recently enrolled into care and treatment around the importance of ART adherence. As a result, 1935 PLHIV have been reached through small groups sessions.


Peer champion facilitating SITETEREKI small groups sessions with young girls in Shinyanga Region

NAWEZA AND SITETEREKI SMALL GROUP SESSIONS

Community volunteers trained in FY19 continued to implement community-level SBC activities to support the NAWEZA and SITETEREKI platforms this quarter. As a result, 48,528 male and female youth were reached through small group sessions promoting MCM and condom use and 45,748 pregnant women and their partners were reached through NAWEZA Pregnancy and Childbirth package small group sessions. A total of 137,610 individuals were reached through multi-session small group activities, with 92% completing all four activities in the series.

Community health worker (CHW) facilitating NAWEZA small groups session with a group of pregnant women and their partners in Katerero ward Bukoba DC

FURAHA YANGU SMALL GROUP SESSIONS AND SERVICE COUPONS

Community volunteers continued to implement Furaha Yangu small group sessions targeting at risk men and women to improve the uptake of targeted HTS. During this reporting period, 49,289 individuals were reached and engaged through Furaha Yangu sessions. The project continued to focus participant recruitment in high risk areas which were identified in FY2019, and routinely updated the list with new areas, which will be used as a basis to recruit individuals to participate in Furaha Yangu small groups session during this FY. The project used the network of volunteers to identify high risk areas by looking at common higher-risk contexts, such as agricultural or industrial areas that attract migrant laborers, or where social and cultural practices that are risk factors for HIV transmission (e.g., transactional sex work and transport corridors) occur. Further, community volunteers continued to support the distribution of Furaha Yangu print materials in strategic community settings and facilities.

Amina Nyagawa (CHW) facilitating a Furaha Yangu session with at-risk men in Mtwango ward Iringa

IR 2.3 CONTINUE IMPLEMENTATION OF THE COMMUNITY PROGRAM IN 29 ENHANCED DISTRICTS

2.3.1 Continue rolling out community-level SBC activities in alignment with the adult and youth platforms


COMMUNITY RADIO

The project continued working with community radio stations, which were engaged in FY19 to produce and air participatory radio programs to support the adult and youth platforms. During this reporting period, a total of 92 radio programs were aired across 11 radio stations to support SITETEREKI and NAWEZA communication objectives. In upcoming quarters, the project is planning to intensify radio programming basing on district priorities. For example, in FP priority regions, the project will produce and air more FP radio programming and will engage target audiences in live radio discussion sessions on FP-related topics.

A group of youth participating in live radio round table discussion

S/N HEALTH AREA EPISODE TITLE BEHAVIORAL OBJECTIVES TARGET AUDIENCE

PRIMARY SECONDARY 1 EBF (MNCH) Myths, beliefs, and

misconceptions around EBF within an hour after delivery and up to six months

Breastfeed your baby within an hour after delivery and continue to breastfeed exclusively for 6 months

First-time mothers (18-49)

Male partners, other influential family members, and health care workers

2 HIV Prevention of maternal to child transmission (PMTCT)

What are obstacles around HIV testing for babies born from HIV positive mothers or unknown HIV status mothers

Return your baby to clinic (PNC) for HIV testing around 4-6 weeks if the mother is HIV positive or her status unknown

Mothers who have delivered recently

Male partners, other influential family members and health care workers

3 Malaria Don’t put yourself at risk (Usijitie katika hali hatarishi)

Sleep under ITNs everyday if you are pregnant or have a children under 5

Pregnant women and women with under 5 child/children

Family members and other influential people from the community

4 Malaria Be smart. Sleep well. (kuwa mjanja lala salama)

Sleep under ITNs everyday if you are pregnant or have children under 5



5 Malaria Show that you care (Onesha kuwa unajali)

Sleep under ITNs everyday if you are pregnant or have a children under 5



6 Malaria Myths, beliefs, and misconceptions towards ITNs

Sleep under ITNs everyday if you are pregnant or have children under 5



TABLE 13. SUMMARY OF RADIO PROGRAMS BROADCAST THIS REPORTING PERIOD


S/N HEALTH AREA EPISODE TITLE BEHAVIORAL OBJECTIVES TARGET AUDIENCE

PRIMARY SECONDARY 7 Malaria Where can I get ITNs? Sleep under ITNs

everyday if you are pregnant or have children under 5



8 Malaria The truth about ITNs Sleep under ITNs everyday if you are pregnant or have a children under 5



9 FP I am young, not married, and pregnant

Use of MCM Youth 15 – 24 years Parents, Influential family members, HCWs, traditional and religious leaders

10 FP I am young, in love, and I want to use MCMs

Use of MCM Youth 15 – 24 years Parents, Influential family members, HCWs, traditional and religious leaders

11 FP No shame Correct and consistent use of condoms

Youth 15 – 24 years Parents, Influential family members, HCWs, traditional and religious leaders

12 HIV Beliefs, myths and misconceptions on condom use

Correct and consistent use of condoms


13 HIV Where to get condoms Correct and consistent use of condoms


14 MNCH Beginning of a healthy life, breastfeed within the first hour of birth

Initiate breastfeeding within the first hour of birth

Pregnant women and their partners

Influential family members, traditional and religious leaders

15 MNCH Bring your infant to the clinic for early HIV testing if the mother is HIV positive

Bring your infant to the facility for an early visit at four to-six weeks and for HIV testing if the mother is positive or status unknown



16 MNCH Bring your infant to the clinic for another HIV testing after stopping breastfeeding

Six weeks after stopping breastfeeding, bring your baby to the clinic for another HIV testing



17 HIV Have you tested for HIV?

Go for HIV testing and counselling (if at risk)

Youth 15-24 years Parents, Influential family members, HCWs, traditional and religious leaders

18 HIV Now let’s get test for HIV

Go for HIV testing and counselling (if at risk)


19 HIV I am living good with HIV Go for HIV testing and counselling


20 HIV I am accepting my HIV status

Go for HIV testing and counselling



IR 2.5 STRENGTHEN APPROACHES TO ENSURE GREATER GOT INVESTMENT AND RESOURCING OF SBC

2.5.1 Participate in Comprehensive Council Health Plan (CCHP) process across 29 enhanced districts USAID Tulonge Afya, in collaboration with Regional Health Promotion Coordinators (RHPC) and District Health Promotion Coordinators (DHPC) developed a list of health promotion activities and budget which will be incorporated into the 2020 council plans. In order to ensure that USAID Tulonge Afya activities are featured in the CCHPs, the project supported a team of President’s Office of Regional Administrative and Local Government (PORALG) staff to visit all 29 enhanced districts and meet with the district authorities to explain how USAID Tulonge Afya health promotion activities should be incorporated into the CCHPs. Regional teams are following up with DHPCs to ensure that project activities are featured in council plans.

IR 2.6 ENHANCE APPROACHES TO COORDINATE AND SHARE PROGRAM LEARNING AT DISTRICT AND REGIONAL LEVELS

2.6.1 Provide intensive community mobilization activities to support school-based netdistribution During this reporting period, the Government, through the MOHCDGEC distributed ITNs through schools in four PMI regions (Mwanza, Geita, Kigoma, and Kagera). USAID Tulonge Afya provided intensified community-level SBC support to engage community members to:

• Increase the proportion of parents and caregivers who support their eligible child to bring home an LLIN

• Increase the proportion of parents and caregivers who hang a net

• Increase the proportion of heads of households who have more nets than they need to cover the sleeping spaces and who are willing to share extra LLIN with their neighbors/friends

In order to support these behavioral objectives, USAID Tulonge Afya implemented community level activities, including community theater events, and broadcast radio spots and conducted media expert interviews. In total, 21,928 people were reached through mid-media events. The project also engaged four (Kasibante FM in Kagera, Joy FM in Kigoma, Storm FM in Geita, and Jembe FM in Mwanza) regional radio stations to support ITN use. A total of 3,498 radio spots were aired during this reporting period and 97 expert interview/vox pops were conducted.


Improved systems for coordination and implementation of SBC interventions

3

IR 3.1 STRENGTHEN INSTITUTIONAL COMPETENCIES (SYSTEMS LEVEL)

3.1.1 Support the HPS to develop HPS’ annual operational plan This quarter, USAID Tulonge Afya supported the HPS to develop its Annual Operational Plan, which will be implemented between 1st July 2020 and 30th June 2021. Support provided included direct technical and financial support for the five-day planning workshop in Morogoro. The technical support included direct facilitation of the planning sessions, providing guidance for the process and getting our staff work with the groups in the planning team. The outcome of this planning workshop was a costed annual operational plan of health promotion activities to be implemented by the HPS during the Tanzania government’s financial year 2020/2021, including activities to be completed in collaboration with partners including the USAID Tulonge Afya project.

FIGURE 17. Group photo of participants in the Annual HPS operational Planning Workshop in Morogoro. The HPS Assistant Director Dr Amalberga Kasangala is on the front row, third from left.

3.1.3 Improve health promotion reporting by integrating key indicators into the district health information system 2 (DHIS2) and developing a data visualization dashboard The data visualization dashboard will provide decision makers with easy access to community level SBC data to inform improved decision-making. Milestones completed toward this effort in Q1 include:

• Convening a high-level national technical committee to guide this effort, and creation of a task force and task force terms of reference

• Mapping of partners implementing community-based activities by geographic coverage • Creation of data entry forms for the health management information system Book 10 in the DHIS2 ready

for data entry • All proposed indicators for HPS have been mapped to data elements in the DHIS2• A subset of indicators were proposed as starting points for the dashboard. These will be tested in Q2 in

the development server, then migrated to the training server ahead of a launch of the dashboard. This is expected to happen during the national launch of the CHW Uturo Model in February 2020.


IR 3.3 INCREASE OPERATIONAL AND TECHNICAL SBC CAPACITY (COMMUNITY AND INDIVIDUAL LEVELS)

3.3.1 Provide TA to HPS to implement the SBC capacity strengthening plan developed in FY19 In quarter one, the project provided TA to HPS to ensure some of the prioritized activities for HPS capacity strengthening are included in the annual operational plan and are costed.

3.3.3 Increase SBC capacity among GOT and local IPs In Q1, the project extended its capacity strengthening support to PORALG’s health division by conducting a three-day SBCC basic orientation program to the senior national level leadership of the PORALG health department. The orientation was conducted in Dodoma in October 2019 and aimed to increase awareness and understanding of the role of contemporary SBCC approaches in transforming social norms and promoting healthy behaviors.

A total of 33 officials participated in the training from different departments and sections within the PORALG’s division of health services, including the Division’s Director Dr Ntuli Kapologwe. The training was facilitated by SBC experts from USAID Tulonge Afya and used a curriculum and materials that the project specifically developed and tailored to suit PORALG’s needs. There was an increase of 49% between pre- and post-training assessment scores, suggesting a strong grasp of the training material. Participants reported that they found session on planning and supervising SBC activities particularly relevant and interesting.

Participants developed an application plan to outline ways in which they would apply training knowledge to their work. This included development of a checklist to improve their supervision of SBC activities and follow up to ensure SBC activities are included in CCHPs.

IR 3.4 SUPPORT HPS ON RISK COMMUNICATION AND COMMUNITY ENGAGEMENT FOR EBOLA VIRUS DISEASE (EVD)

This quarter, the project supported the secondment of two GOT staff to HPS to support coordination of risk communication and community engagement (RCCE) activities from the national level. A scope of work and performance monitoring checklists were developed for these staff and approved by HPS. Additionally, the project provided TA for a material development workshop during which print materials, four radio spot scripts, and one TV advert were drafted. The project then supported the recording of two radio spots from the developed scripts.

A media training power point was developed in draft by FHI 360 and shared with both HPS and BBC Media Action. Training and guide development was undertaken by BBC Media Action with technical support from FHI 360 on a community radio manual.

The project also provided technical support to the development and finalization of training materials for RCCE committee members at district and regional levels. This included technical guidance in instructional design and production of a curriculum with learning outcomes, content outline, and instructional strategies. The project also supported review of existing SBCC print materials currently in use by the Red Cross to align with local context in terms of the language and images that are deemed to be socially appropriate.


Upcoming Main Activities in Q2


• The Parenting and Caregiving Package SBC resource package will be approved for roll out

• Three zonal stakeholder orientation meetings to introduce and roll out the new resources under the Parenting and Caregiving SBC package and SITETEREKI

• Airing of NAWEZA Parenting and Caregiving package, Sitetereki platform and Furaha Yangu phase II and III, thematic radio spots across national and regional radio stations

• NAWEZA Season Two radio show production and broadcasting of the first four episodes

• Finalization and implementation the SNET process operational plan to identify and inform social norm prioritization decisions

• Rollout and implementation of community radio programs to support NAWEZA, SITETEREKI, and Furaha Yangu

• Development, pre-testing, and finalization of PrEP and HIVST introductory set of core demand creation materials

• Finalization and submission of TLD transition, index testing elicitation reference sheets and U=U treatment literacy video for approvals

• Continuation of Treatment Advocate PLHIV small group dialogue sessions across 6 PEPFAR high volume site regions.

• A participatory co-design workshop leveraging LTFU reporting findings to inform development of brhavioural profiles at risk of LTFU, including counselling and community support materials

• Rollout and implementation of community theater activities across 29 enhanced districts

• Orient volunteers on new Caregiving packages and rollout of community level IPC sessions

o SITETEREKI – HIV, VMMC, FP

o NAWEZA – Parenting and care giving packages in addition to the Pregnancy package

• Continue rolling out IPC community level activities to support SITETEREKI and Furaha Yangu

• Rollout SITETEREKI media push to boost brand awareness and engagement

• Continue to support the digital platform

• Continue to monitor project implementation.


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SUCCESS STORIES

AT LAST THE CHILD WAS BORN IN THE FACILITY

Salome Elisha is a 43-year old resident of the Chifunfu ward. Salome became pregnant and ‘as usual’ her tendency was to deliver at home. She had no plan to go to the hospital.

Her neighbor, Mr. Buswelu, invited her to attend a NAWEZA session, which she refused to attend because of pregnancy complications. As she was eight months pregnant, she was very exhausted.

A USAID Tulonge Afya CHW decided to talk to Salome’s husband and invited him to attend the session, which was a success. The husband attended the sessions and at first, he began to lose interest as the topics were covering issues related to early clinic attendance and his wife was approaching her 9th month of pregnancy.

He gained interest on the second day when they discussed post-natal care and services they can receive if his wife delivers at the health facility, instead of at home. He also learned about the benefits of PNC, including the use of MCMs after delivery. It was good news to Salome’s husband, who also had future plans for his family. He had wanted only four children in his life, and at this time, he had seven. for him, this was more than enough.

Salome’s husband played a positive role in convincing Salome to deliver her baby boy at the hospital. It was a good experience for Salome and her husband as they were advised on FP methods and learned a lot, especially on the danger signs during pregnancy.


Salome Elisha with Service provider at Ngoma Mtimba

Salome Elisha breast feeding her son dispensary (chinfunfu ward)


List of Annexes

ANNEX 1: RADIO SPOTS ENGAGED TO SUPPORT SCHOOL NET DISTRIBUTION.XLSX

ANNEX 2: SNP MEDIA.XLSX

ANNEX 3: SITETEREKI RADIO SPOTS.ZIP

ANNEX 4: APPROVED SITETEREKI MEDIA PLAN.XLSX

ANNEX 5: MALARIA AUDIENCE INSIGHTS SUMMARY REPORTS_ZANZIBAR.PDF

ANNEX 6: SNET_CONCEPT NOTE_FINAL_REVISED

ANNEX 7: FURAHA YANGU PHASE II & III APPROVED RESOURCES.PDF

ANNEX 8: DIGITALIZED GBV INTERACTIVE DIALOGUE TOOLKIT.PDF


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